Part 1 of a 2-part series
By Sanna Yoder, Senior Director, Content Strategy and Behavior Design, RedBrick Health

No matter what the make-up of your population, there’s a cost-effective prescription for better health—one that may help lower blood pressure, reduce the effects of depression and anxiety and improve sleep. It may even help control cravings.1

It is called mindfulness, and it’s a practical solution to address the stresses of everyday life.

Mindfulness costs nothing but a few moments of time. It can be practiced anywhere. And while it can help employees feel better in the moment, it may even have a long-term impact, improving job performance, reducing turnover intention2 and increasing the resiliency of your work group.

But how do you “get mindful?” Or promote the practice in your work group? Do you have to carve out 20 minutes to sit and meditate? Do you need special training? Do you have to leave your desk or listen to a soothing voice? Do you have to close your eyes?

These are all valid aspects of being mindful, but sometimes, in the hectic pace of today’s workplace, they’re impossible. That’s why many mindfulness experts promote what author and scholar Karen Kissel Wegela calls informal mindfulness practices,3 or everyday activities that can support an attitude of mindfulness. Here are a few of her suggestions:

Simply pay attention to the sights, sounds, colors and movement around you in the moment.

Try neither too little nor too much.

Pay attention to what’s happening in your body.

Let go of distractions.

Rick Hanson, psychologist, best-selling author and senior fellow at UC Berkeley’s Greater Good Science Center, encourages a practice known as Taking in the good. Hanson asserts that the human brain is wired to be like Velcro® for bad experiences and Teflon® for good. It takes at least 20 to 30 seconds for a good experience to register, sink in and rewire the brain into feeling more relaxed, at peace, resilient and ready to take what comes. Focusing for 10, 15, even 20 seconds periodically throughout the day on a positive experience like feeling secure, feeling tenacious or expressing gratitude can reinforce the good.

Here’s a brief exercise from RedBrick Journeys® you can try right now:

Look at your cup of coffee—now imagine all the help that got it to you, from the farmer who grew the coffee beans to the artist who designed your mug.

A few seconds well spent. In part 2 of our series, we’ll take you through a few more mindfulness exercises you can use for an immediate impact on your day—or your work group.

A recent survey of employers with more than 500 employees confirmed what many of us expected to see—a continuing rise in outcomes-based incentives programs.1 Our own survey research shows a strikingly similar trend among employers with more than a thousand employees: Many are moving to outcomes-based designs.2

It seems like a logical assumption is being made here—outcomes-based models that tie rewards to key behavioral and biometric results are likely to produce better biometric outcomes.

But is there evidence to back up that assumption?

We recently reviewed the year-over-year program results of over 80 reward designs that reached nearly 500,000 individuals. We divided the sample into four reward design types:

Participation-based models that rewarded members with dollars or points for completing a health assessment, screening or other behavior, with no tie to a healthy result.

Partial outcomes-based models that rewarded points or credits for biometric measures within a healthy range (subject to the availability of reasonable alternative standards), and also for participation in healthy activities.

Outcomes-based models that penalized those whose biometrics were not within a healthy range and required them to “earn money back” through risk-matched reasonable alternative standard activities.

Programs where there was no incentive or punitive outcome.

Here’s what we found. Engagement levels were positively associated with improved biometric outcomes. So were reward levels. (In fact the two are highly correlated, so it’s likely the effect of rewards is really the lift they create in engagement.) However, we could find no statistical evidence that participants in outcomes-based models achieved better outcomes than those in other models.2 That’s not to say it isn’t there—we just didn’t see it in this large sample.

So the answer according to this analysis is no, outcomes-based designs do not produce better outcomes than participation-based designs. That may be a relief to those who’ve felt pressure to join the trend toward outcomes-based reward designs, but were concerned about backlash.

The takeaway: If you’re going to focus on one thing, focus on what gets you real engagement in your population, whatever that might be. It’s engagement that gets you results.

Part 3 of a 3-part series
By Nathan Barleen, Director of Research, RedBrick Health

In parts 1 and 2 of this series, we presented the case for choice for engaging individuals in their health and the role choice can play for those with chronic conditions. In this post, we’ll talk about how different segments of consumers respond to different options when offered in a choice-based health management model.

Choice allows individuals to exercise their preferences. Traditional and online merchants have studied the differences between customer segments for years. Merchants know that different marketing approaches and product types appeal to different individuals. In order to maximize sales, they often organize choices in a way designed to appeal to each segment of their audience.

Consumer engagement in wellness activities can be approached the same way. We set out to learn how different types of individuals choose to engage in wellness programs. We found that some characteristics of our consumers, like age, location, company type and geographic region, were predictors of how these individuals responded to wellness program options.

When we controlled for differences in incentives and communication we found some interesting patterns with respect to who chooses phone coaching, who selects a virtual coaching experience, and who prefers simply tracking daily habits.

It takes more than apps and wearables to reach all segments of the population

Given the choice, most of our participants selected a digital form of health engagement, but some opted for the support of a live coach. We found that those who chose to work with a live coach were more likely to be:

Over 50

Working in a manufacturing or service industry

Living in a lower income, rural area

Living in a Midwestern state

In contrast, our digital users (including our virtual coaching users) tended to be younger, work in a white-collar setting, and live in mid- to upper-income suburban or exurban neighborhoods. Our self-trackers (including those who chose to sync a phone app or wearable device) were our youngest users, and most likely to live in higher income and urban areas.

Seem like an intuitive finding? Maybe so. However, it’s important to recognize that the risk and healthcare cost distribution within many working populations skews toward those that, based on our research, prefer the live coaching option.

That’s a core reason why we believe that a best practice population health model offers choice, including the options to work with a coach, use a virtual coaching app or track daily activity with integrated devices. Limiting engagement options may make the path to wellness more difficult for some consumers—and some may not get on the path at all.

The upward trajectory of healthcare costs has given rise to a debate about the value of annual health screenings. Are they really necessary? Do they surface enough potential medical issues to outweigh the costs of screening an entire population?

At RedBrick, we’ve screened hundreds of thousands of consumers across the organizations we serve. This experience, along with the evidence we’ve gathered, has convinced us that periodic health screenings as part of a workplace health and wellness program make sense.

Screenings can help to:

Identify health conditions early. The obesity epidemic is driving higher rates of hypertension and diabetes and even worse, a significant percentage of people with these conditions don’t even know it. Screenings can catch these health conditions earlier, before complications and high costs occur. For example, we’ve seen very clinically-meaningful improvements in blood pressure in our studies, in large part because individuals with screening measurements outside a normal range are directed to seek medical treatment.

Encourage compliance with treatment. Regular screenings remind those with biometric risks about the importance of following recommended therapies.

Drive engagement. Screenings raise awareness of health risks, and are often the “call to action” people need to make a change in their health behavior.

Save lives. They bring to light biometric measures that are considerably outside a normal range so those individuals can be referred for immediate medical attention. Just measuring blood pressure is likely to save 2-3 lives per 50,000 people screened every year. Our consumer success stories include examples of individuals who were referred for immediate medical intervention as the result of a screening, in some cases with life-saving results.

We recognize that the USPSTF and other professional organizations have very specific recommendations based on each individual’s specific health status and risks that differ from a yearly screening, yet highly personalized screenings are not practical or cost effective for large populations. Identifying common and costly risks is the first step toward increasing the overall health and well-being of your population.

Karin Bultman, RedBrick’s vice president of market development, participated on a recent panel at the Health Access Summit. The following is based on her presentation titled “It’s How You Say It” – Strategies for Optimizing Health Communication and Engagement. Karin offered the audience the top 10 things RedBrick’s learned about crafting engaging health communications so audience members could consider them for their own programs.

We know you invest a lot of time and money communicating health and wellness initiatives to your consumers. But are those messages helping you meet your goals? How do you ensure your communications are effective, engaging, and inspiring your consumers to better health?

The recently retired David Letterman made the Top-10 list an institution. We’re continuing the tradition with our own list, Top 10 tips for creating engaging consumer health communications:

Conduct A/B tests. Do mini-experiments to learn what works best for your audience. Try issuing the same email to two different groups using a different headline on each one to see what type of message gets you a higher open rate.

Be trustworthy. Consumers need assurance that you know what you’re talking about. Some of the ways to instill trust include referencing relevant accreditations and recognitions, quoting respected experts and using citations.

Provide appropriate context. Explain, in simple language, why the health information is important, especially when you’re requesting information from your consumers. Be aware that your audience might be sensitive to some health topics. Use both visuals and words for clarification.

Test for reading level. Follow plain language guidelines, and evaluate text using built-in tools or other gold-standard tests. Know how to swap out or interpret challenging health terms so they’re more easily understood.

Meet consumers where they are. Health behavior changes must fit into everyday life if participants are going to continue to follow them. Present flexible options with varying levels of difficulty, complexity or duration to encourage ongoing participation.

Invest in localization. The language and culture of the recipient will affect how they interpret your message. Do multiple translation reviews and use idioms wisely to avoid confusion. Make sure to offer culturally appropriate options and suggestions.

Include great visual design. Pictures boost comprehension. Incorporate illustrations and photos into your communication design—and make sure to do this as part of the original design, not as an afterthought.

Listen to your consumers. Ask your consumers what they find engaging and useful. Gather this information using techniques like focus groups, surveys and comments. Make revisions based on what you learn.

And the number 1 tip for communications that engage and inspire consumers…

Design for behavior. Don’t just tell consumers what to do. Give them reasons to act. Apply behavior theory and choice architecture. Tap participants’ intrinsic motivations. Build in social support and feedback. And most of all, don’t sound too serious or earnest. Make it fun—if it feels like a chore, consumers will eventually drift away.

Part 2 of a 3-part series
By Dr. Jeff Dobro, Chief Medical Officer, RedBrick Health

In part 1 of this series, we presented the case for choice for engaging individuals in their health. We found that by putting the person back into the personalization—letting individuals select their own healthy activities and way to interact—we were able to find equivalently strong impact on health results regardless of the choice between live coaching, virtual (or digital) coaching, and self-tracking.

In part 2 we focus on the segment of the population with chronic conditions—a group that can comprise up to 20% of the typical working population and drive up to 80% of total healthcare costs.

A traditional health management stratification design would focus on recruiting these high-risk, high-cost individuals into intensive phone coaching, and specifically into a disease management intervention. At RedBrick, we do condition management, but we let consumers choose where to place their focus. Why? Choice allows them to exercise their preferences and taps their intrinsic motivations—like improving appearance, living longer to see their kids and grandkids grow up, boosting energy, or fitting into a smaller size—that encourage engagement.

And, as it turns out, given the choice, 80% of those with a chronic condition choose to focus their coaching experience on a lifestyle issue—like nutrition, exercise, weight loss or stress. And we let them. By using a whole person approach we avoid the pitfalls of treating people as disease states, risk factors or body parts. We start with what’s relevant for them and consistent with preferences and intrinsic motivations.

Is this “choice architecture” driven approach clinically defensible? We think so. Key clinical topics are covered on every coaching call: Medication compliance and condition monitoring, working effectively with your doctor, self-management plans, health education and overall well-being. We make sure to weave in a call with a nurse to review their condition in detail during at least one out of four coaching sessions And, somewhat paradoxically, by letting people choose their focus, we end up coaching three times as many people on issues that are still highly relevant to their condition, and four times as many people in total. Using our small steps approach, we build upon each small success and drive a much broader level of clinically-relevant results than a standard disease management approach.

As it turns out, health improvement isn’t a linear process. Lifestyle habits affect chronic conditions, and a change in a chronic condition will, in turn, impact day to day lifestyle behaviors. Getting more active reduces weight, which helps mitigate blood pressure, elevated cholesterol and diabetes. Psychologically, making a single, small improvement builds self-efficacy and making consistently healthier choices helps re-shape self-perception.

When it comes to helping individuals better manage chronic conditions, start with choice.

In part 3 of this series, we’ll explore how different populations respond to different engagement modalities—and why to avoid a “one-size-fits-all” approach.

Part 1 of a 3-part series
By Eric Zimmerman, Chief Marketing Officer, RedBrick Health

At RedBrick, we’ve been saying for years that creating consumer ownership of health means providing strong, data-driven guidance, but ultimately letting consumers make choices. This idea may sound logical, but surprisingly it flies in the face of conventional health management models. Conventional wisdom says use risk data to identify and stratify populations and select the intervention for the consumer. Those at higher risk get phone coaching. Chronic illness? Disease management. Everyone else? Offer low cost portals, newsletters, self-trackers.

While it seems logical to stratify populations by risk level and to focus the more costly interventions on those at higher risk, the approach leaves someone out of the decision process: The consumer. But can a choice-based model produce real outcomes?

Instead of following the traditional health risk stratification model, we used data to offer a bounded set of pre-prioritized choices, applying a core principle of behavioral economics called choice architecture. We recommended three personalized focus areas—like stress, nutrition or a health condition—but didn’t limit people to focusing on their highest risk or chronic condition. And we let individuals decide how they’d like to engage. They could choose a convenient digital coaching (online) option within their chosen focus, they could opt for the use of a digital daily activity tracker that connects to popular apps and wearable devices or they could take advantage of the opportunity to work one-on-one with a behaviorally trained coach on the topic of their choice.

Conventional wisdom would suggest that the more resource intensive phone coaching would produce superior results. However, we found a different, and somewhat surprising, result: When consumers were allowed to choose their intervention focus and modality, they achieved clinically meaningful improvements at almost identical rates. Live phone coaching worked. So did digital (online) coaching. As did online self-tracking with connected apps and devices. No modality outperformed the others.

What does this finding mean? Our view is that it means choice works: It produces better engagement and stronger personal commitment. It lets people start where they are, rather than where a risk-streaming algorithm suggests they should be. In other words, it puts the person back into the personalization.

In Part 2 of this story, we’ll look specifically at those with chronic conditions and the impact of choice within coaching on the level of engagement in condition-relevant coaching.

Helping people be healthy is our motto. Every day we imagine, design and build technology to help our clients provide an engaging environment to foster better health, and we couldn’t do it without the wealth of industry knowledge and experience of our RedBrick Health employees.

One such distinguished personality is Susan Bailey, Director of Client Services. While often seen in our Minneapolis headquarters, Bailey is based in Michigan and provides strategic consultation for both RedBrick Health clients and the non-profit Michigan Wellness Council. In 2015-2016, she will lead the board as Michigan Wellness Council Chair.

The Michigan Wellness Council partners with local employers and the state to bring successful wellness best practices to the workplace, operating as a hub of quality resources and forums. Bailey has been working with the Michigan Wellness Council in a variety of roles for eight years, and is excited to start her first two-year term as Chair.

Congratulations, Susan! We’re excited here at RedBrick Health to see your next steps as a leader in the health and wellness industry.

At RedBrick Health we work every day to help people be a little bit healthier than they were yesterday. That work doesn’t stop with our clients and partners – it’s something we strive to include in our own offices, communities and lives.

“For me, helping people be healthy is much more than a job; it’s a lifestyle,” said Joe Garrison, our Southwest regional sales leader. “I believe in what we do at RedBrick Health and I’m striving to lead by example.”

Garrison, who is based in California, has been working with RedBrick since 2010, and he’s been doing triathlons for just as long. This summer he completed eight Olympic distance triathlons and a half-IRONMAN in preparation for his first full IRONMAN in November.

An IRONMAN is the ultimate triathlon, composed of a 2.4-mile swim, 112-mile bike and a 26.2-mile run. Garrison will be racing at the Tempe, Arizona course, known as the premier mainland race due to atmosphere, surrounding events and strong IRONMAN tradition.

RedBrick will be matching Garrison’s entry fee dollar amount with a donation to the IRONMAN Foundation. The Foundation has supported global, national and local charities with $18 million in grants and donations since 2003.

We’re very excited to support Garrison in his first IRONMAN race, his donation to the IRONMAN Foundation and his efforts to be healthier every day and inspire others to do the same. Good luck in Tempe, Joe!

If you are a new or current RedBrick Health member looking for assistance, please email youradvocate@redbrickhealth.com . If you are an organization interested in learning more about or partnering with RedBrick Health, please fill out the form below.